10 key takeaways on the Stage 2 meaningful-use proposal By Marie Copoulos, Health Care IT Suite, The Advisory Board Company

MEANINGFUL USE

On Feb. 23, 2012, CMS re- leased the notice of proposed

rule making (NPRM) for Stage 2 of the EHR Incentive Program, which advances the next set of criteria that eligible hospitals (EHs) and eligible providers (EPs) must demonstrate to continue to successfully achieve meaningful use.

While proposals for the next phase of core and menu set requirements largely mirror the direction the Health IT Policy Committee’s recommendations made during the summer of 2011, they are on the whole more ag- gressive. This is unsurprising given that everything that is ultimately included in the fi nal rule on Stage 2 – due out summer 2012 – must be vetted in the proposed rule. Here are 10 of the most important takeaways con- tained in the proposal: 1. Centers for Medicare & Medicaid Services (CMS)

affi rms a delay for 2011 attesters. As expected, CMS has proposed that 2011 attesters will transition to Stage 2 in 2014 instead of 2013, as initially required. All other providers will remain on schedule. 2. Stage 1 requirements will be updated come 2013. Not only has CMS proposed new measures for Stage 2, but it has also proposed an update to Stage 1 measures that better align them with the program’s strategic direction. Providers attesting to Stage 1 come 2013 will have the option to report on these new criteria. Starting in 2014, these new Stage 1 criteria will become mandatory. 3. Medicaid defi nitions are loosened; more providers

are eligible. CMS has issued defi nitional modifi cations to patient encounters and children’s hospitals in addition to clarifi cations on volume determination for multi-physician practices. These act to expand the pool of providers eli- gible for the Medicaid program, expanding the number of EPs and EHs eligible for Medicaid incentives.

4. While the total number of objectives does not grow, Stage 2 measure complexity increases sig- nifi cantly. While a number of Stage 1 measures no longer exist as indepen-

dent measures, these concepts are subsumed without exception into new requirements. Stage 2 measures are, on the whole, more involved than Stage 1 measures. For example, it is not uncommon for a measure to have multiple parts. 5. Information exchange will be key, but a health

information exchange (HIE) will not be necessary. CMS has embedded information exchange into a number of measures, the most signifi cant of which is the require- ment that 10 percent of summary of care records be transmitted electronically. Use of Direct – essentially secure email – will be suffi cient. 6. Patients will need to act for providers to suc-

ceed. The concept of a patient request is eliminated in Stage 2; instead, providers will need to proactively offer patients their health information. Further, pa- tients will need to view, download or transmit their health information at a 10 percent threshold. While CMS continues to express its intent to transition to outcomes measures, this is the fi rst that has been proposed and is likely to be at the center of debate in public comment.

7. Sharing of health data will force real-time, high- quality data capture. While problem, medication and medication allergy lists are no longer measures unto them- selves, they have been subsumed within the summary of care record and patient health information requirements. Far from diminishing them, this will force providers to move beyond measurement (i.e., at least one problem per unique patient), as patients and clinicians view this

PUBLICATIONS

“Privacy: The Impact of ARRA, HITECH, and Other Policy Initiatives,” by Jill Callahan Dennis, JD, RHIA, is a great

companion guide for organizations implementing the health information privacy and security provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). Topics in- clude key provisions of the legislation, operational challenges and possible implementation strategies, and an overview of some of the other privacy- and security-related policy efforts now underway. This book will be useful to a range of users – both those experienced with health information privacy is- sues and those just beginning to work with ARRA’s HITECH provisions.